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Zhou V, Reddick M, Lamus D, Arellano RS, Kalva SP. A Simple "Involute" Technique for Successful Removal of a Caudally Migrated "Viatorr" Stent Graft. Semin Intervent Radiol 2024; 41:92-96. [PMID: 38495265 PMCID: PMC10940037 DOI: 10.1055/s-0044-1779710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
- Vellia Zhou
- Tufts University School of Medicine, Boston, Massachusetts
| | - Mark Reddick
- Radiology Associates of the Fox Valley, Neenah, Wisconsin
| | - Daniel Lamus
- Division of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ronald S. Arellano
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjeeva P. Kalva
- Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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2
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Khayat M, Khayat A, Chick JFB, Healey TL, Srinivasa RN. Percutaneous Interventional Radiology-Operated Endoscopy for Foreign Body Removal. Tech Vasc Interv Radiol 2019; 22:149-153. [PMID: 31623755 DOI: 10.1053/j.tvir.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Image-guided retrieval of endovascular devices such as inferior vena cava filters, guidewires, and stents is well reported, though there is a paucity of published reports on biliary, genitourinary, or gastrointestinal foreign body retrieval utilizing percutaneous endoscopy, particularly when it is performed solely by interventional radiologists. In cases of failed traditional endoscopic techniques or to evade more invasive surgical options, percutaneous endoscopy can be an adjunctive tool employed by interventional radiologists to extract foreign bodies. In this article, clinical evaluation, perioperative management, and procedural techniques for biliary, genitourinary, and gastrointestinal endoscopy for foreign body retrieval are reviewed.
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Affiliation(s)
- Mamdouh Khayat
- Department of Radiology, Division of Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center, Columbus, OH.
| | - Adam Khayat
- Department of Biology, University of Louisville, Louisville, KY
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA 98195
| | - Travis L Healey
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Ravi N Srinivasa
- Department of Radiology, Division of Vascular and Interventional Radiology, UCLA Medical Center, Los Angeles, CA
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Su Q, Ding X, Dong Z, Liu Y, Li G, Jiang J. A Modified Loop Snare Technique for Difficult Retrievals of Inferior Vena Cava Filter and Migrated Coil. Int Heart J 2019; 60:93-99. [PMID: 30518716 DOI: 10.1536/ihj.18-075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the safety and efficacy of a modified loop snare technique for retrieval of difficult inferior vena cava (IVC) filters and migrated coils.A retrospective review of Günther Tulip filter retrievals between January 2014 and February 2017 was performed. A total of 316 IVC filter retrievals were attempted. In 25 cases, the standard technique had failed and our modified loop snare technique was subsequently attempted in 21 of these patients.The retrievals were successful in 20 cases (mean dwell time, 42.6 days, range, 14-102 days). The dwell time of the one failure was 46 days. The retrieval rate increased from 92.1% with the standard technique to 98.4% with the combination of the standard and modified loop snare technique. Unsuccessful retrieval was due to migration and endothelialization of the filter. This technique can also be used to remove migrated coils which cannot be captured by standard techniques. There were no complications from the retrievals.Tilt and endothelialization of filters are the main factors resulting in unsuccessful retrievals with the standard technique. In the present study, we describe an alternative technique for difficult IVC filter retrievals, which can also be used to capture migrated coils and occluders in the aorta and heart.
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Affiliation(s)
- Qingbo Su
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Xiangjiu Ding
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Zhaoru Dong
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Yang Liu
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Guangzhen Li
- Department of Vascular Surgery, Qilu Hospital of Shandong University
| | - Jianjun Jiang
- Department of Vascular Surgery, Qilu Hospital of Shandong University
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Najafi A, Koulia K, Aubert P, Binkert CA. Multi loop snare technique for difficult inferior vena cava filter retrievals. CVIR Endovasc 2018; 1:33. [PMID: 30652164 PMCID: PMC6319532 DOI: 10.1186/s42155-018-0042-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
Introduction Use of optional vena cava filters has steadily increased. In the majority of cases removal is successful using standard techniques. In cases of tilting and migration of the filter however, more advanced techniques are necessary. The "loop-snare" technique has been described for such cases. Difficulties arise when the loop starts to slip around the legs and arms of the filter. New technique We present an improved loop-snare technique which allows to retrieve IVC filters when the simple loop-snare technique fails. We used additional loops, in one case one additional loop in another case two additional loops around the filter tip which allowed successful retrieval. The additional loops were created with a reversed shaped catheter. All guidewires were then engaged with a snare and pulled into a large sheath. The additional loops stabilize the tip and the filter can be pulled into the sheath. Conclusion The "multiple-loop-snare" technique is a refinement of the previously described "single loop-snare" technique and can be used when one loop fails.
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Affiliation(s)
- Arash Najafi
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
| | - Katerina Koulia
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
| | - Philippe Aubert
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
| | - Christoph A Binkert
- Institute of Radiology and Nuclear Medicine, Kantonsspital Winterthur, Brauerstrasse 15, 8405 Winterthur, Switzerland
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Delozier A, Ghaleb M, Andrade A. Tine after tine: a varied approach to the removal of a long-standing IVC filter. Radiol Case Rep 2017; 12:335-339. [PMID: 28491183 PMCID: PMC5417753 DOI: 10.1016/j.radcr.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 02/11/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022] Open
Abstract
Inferior vena cava filters are important tools used to help prevent life-threatening pulmonary embolisms in hospitalized patients with contraindications to pharmacological prophylactic anticoagulation. This is a case report of a patient who had an inferior vena cava filter placed after a traumatic subdural hematoma. He made a complete recovery but was lost to follow-up until he presented 1825 days after filter deployment with abdominal pain discovered to be from penetration of the filter tines outside the lumen and into adjacent structures. We describe a case complicated by fibrotic tine entrapment with penetration to surrounding structures and discuss the technical approach used to free and eventually remove the long-standing filter.
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Affiliation(s)
- Andrew Delozier
- Department of Medical Education, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, 4800 Alberta Avenue, El Paso, TX 79905, USA
| | - Melhem Ghaleb
- Department of Radiology, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
| | - Alonso Andrade
- Department of Surgery, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine, El Paso, TX 79905, USA
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Abstract
OPINION STATEMENT Inferior vena cava (IVC) filter placement is indicated for the treatment of venous thromboembolism (VTE) in patients with a contraindication to or a failure of anticoagulation. With the advent of retrievable IVC filters and their ease of placement, an increasing number of such filters are being inserted for prophylaxis in patients at high risk for VTE. Available data show that only a small number of these filters are retrieved within the recommended period, if at all, prompting the FDA to issue a statement on the need for their timely removal. With prolonged dwell times, advanced techniques may be needed for filter retrieval in up to 60% of the cases. In this article, we review standard and advanced IVC filter retrieval techniques including single-access, dual-access, and dissection techniques. Complicated filter retrievals carry a non-negligible risk for complications such as filter fragmentation and resultant embolization of filter components, venous pseudoaneurysms or stenoses, and breach of the integrity of the caval wall. Careful pre-retrieval assessment of IVC filter position, any significant degree of filter tilting or of hook, and/or strut epithelialization and caval wall penetration by filter components should be considered using dedicated cross-sectional imaging for procedural planning. In complex cases, the risk for retrieval complications should be carefully weighed against the risks of leaving the filter permanently indwelling. The decision to remove an embedded IVC filter using advanced techniques should be individualized to each patient and made with caution, based on the patient's age and existing comorbidities.
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Abstract
Over the past decade, there has been a gradual evolution of the retrievable inferior vena cava (IVC) filter, as the indications for caval filtration have expanded since the first such filters came into use. However, the particular design of retrievable or optional filters has introduced a subset of both symptomatic and asymptomatic device failures that have prompted a reassessment in the approach to patient selection as well as a new lexicon of technical considerations when considering retrieval. The Denali Vena Cava Filter (Bard Peripheral Vascular, Inc., Tempe, AZ) represents one of the latest filters to come to market that specifically addresses the various issues of its predecessors. While the body of published experience with this filter is still relatively sparse, the incidence of filter tilt, strut perforation, strut fracture, and filter migration appears acceptably low and the filters remain relatively easy to retrieve even after long dwell times.
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Affiliation(s)
- David Hahn
- Department of Radiology, Section of Interventional Radiology, NorthShore University HealthSystem, Evanston, Illinois
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Lee MJ, Valenti D, de Gregorio MA, Minocha J, Rimon U, Pellerin O. The CIRSE Retrievable IVC Filter Registry: Retrieval Success Rates in Practice. Cardiovasc Intervent Radiol 2015; 38:1502-7. [PMID: 25933644 DOI: 10.1007/s00270-015-1112-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/30/2015] [Indexed: 12/19/2022]
Abstract
CIRSE established a registry of retrievable filter use with the primary aim of determining the success of IVC Filter retrieval and associated complications. Secondary endpoints included filter indications, imaging strategies before retrieval, filter dwell times, and anticoagulation status. A web-based electronic registry was hosted between 01/12/2010 and 30/06/2012. Data entry occurred at the date of IVC filter retrieval and included items such as filter type, indication for filter insertion, access route, dwell time, retrieval success, complications, reasons for failed retrieval, and anticoagulation status. 671 filter retrievals were entered (male:female 333:295, mean age 55, median 57). Retrieval data were not entered in 43/671 leaving 628 patients for analysis. The 4 commonest retrievable filters used were the Celect in 182 patients, the OPTEASE in 161, ALN in 120, and Gunther Tulip in 98. Filters were inserted for absolute indications 40%, relative indications in 31%, and prophylactic in 24%, with 5% missing. Mean filter dwell time was 90 days. Filters were successfully retrieved in 576/628 patients (92%). The mean dwell time for successful retrievals was 85 days versus 145 days for unsuccessful retrievals (p = 0.001). Major complications occurred in 2 patients (0.03%). In summary, the CIRSE retrievable filter registry demonstrates a retrieval rate of 92% across a range of filter types, with a low major complication rate, reflecting current practice. There is an increase in trend of retrievable filter use for relative and prophylactic indications.
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Affiliation(s)
- M J Lee
- The Department of Academic Radiology, Beaumont Hospital, Dublin 9, Ireland.
| | - D Valenti
- Department of Radiology, McGill University, 354 Beaconsfield Blvd, Montreal, QC, H9W4A9, Canada.
| | - M A de Gregorio
- Department of Interventional Radiology, University of Zaragoza, Gomez Laguna, 13, 5° B, 50009, Saragossa, Spain.
| | - J Minocha
- Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, Suite 2483, Chicago, IL, 60612, USA.
| | - U Rimon
- Department of Diagnostic Radiology, Sheba Medical Center, 52621, Telhasomer, Israel.
| | - O Pellerin
- Department of Interventional Radiology, Université Paris 5 René Descartes, Hopital Européen Georges, Pompidou, 20 rue Leblanc, 75908, Paris, France.
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9
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The efficacy of prophylactic IVC filters in gastric bypass surgery. Surg Endosc 2014; 29:882-9. [DOI: 10.1007/s00464-014-3746-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/11/2014] [Indexed: 10/24/2022]
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10
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Open surgical removal of a tilted and dislodged inferior vena cava filter through a lumbar branch without cavotomy. J Vasc Surg Venous Lymphat Disord 2013; 1:304-8. [DOI: 10.1016/j.jvsv.2012.10.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 11/19/2022]
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Dixon A, Stavropoulos SW. Improving retrieval rates for retrievable inferior vena cava filters. Expert Rev Med Devices 2013; 10:135-41. [PMID: 23278230 DOI: 10.1586/erd.12.65] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The introduction of retrievable inferior vena cava (IVC) filters was an important step in the evolution of deep vein thrombosis/pulmonary embolism management. Their removability makes them preferred to permanent filters in many cases. IVC filter retrieval often occurs at a suboptimal rate, leading to complications associated with long-term placement. Improving retrievability includes solutions for patients being lost to follow-up, filter malpositioning, need arising for permanent IVC filtration, filtration requiring longer than the filter's window of retrievability, and filter compromise by the presence of a large trapped clot. This review explores these strategies for retrieval in detail in hopes of improving IVC filter retrieval rates.
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Affiliation(s)
- Austin Dixon
- University of Pennsylvania Health System, 3600 Chestnut Street, Philadelphia, PA 19104, USA.
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Modified Loop Snare Technique for the Removal of Bard Recovery, G2, G2 Express, and Eclipse Inferior Vena Cava Filters. J Vasc Interv Radiol 2012; 23:687-90. [DOI: 10.1016/j.jvir.2012.01.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 01/02/2012] [Accepted: 01/07/2012] [Indexed: 11/30/2022] Open
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Affiliation(s)
- Thuong G Van Ha
- Department of Radiology, University of Chicago, Chicago, IL, USA.
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Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters. Cardiovasc Intervent Radiol 2011; 35:741-50. [DOI: 10.1007/s00270-011-0205-z] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 05/22/2011] [Indexed: 10/18/2022]
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Kondo K, Watanabe H, Iwabuchi M, Nobuyoshi M. Balloon-trapped Technique for Successful OptEase Filter Retrieval. Ann Vasc Dis 2011; 4:40-2. [DOI: 10.3400/avd.cr.10.01041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 12/14/2010] [Indexed: 11/13/2022] Open
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Alomari AI. Percutaneous Retrieval of an Intravascular Fluency Stent-Graft Using a Rigid Alligator Forceps: Case Report. Semin Dial 2010; 23:220-3. [DOI: 10.1111/j.1525-139x.2010.00710.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Removal of the G2 Filter: Differences between Implantation Times Greater and Less than 180 Days. J Vasc Interv Radiol 2009; 20:1200-9. [DOI: 10.1016/j.jvir.2009.05.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 05/09/2009] [Accepted: 05/28/2009] [Indexed: 11/30/2022] Open
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Lynch FC. Balloon-assisted Removal of Tilted Inferior Vena Cava Filters with Embedded Tips. J Vasc Interv Radiol 2009; 20:1210-4. [DOI: 10.1016/j.jvir.2009.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Revised: 05/27/2009] [Accepted: 06/10/2009] [Indexed: 10/20/2022] Open
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Smouse HB, Rosenthal D, Van Ha T, Knox MF, Dixon RG, Voorhees WD, McCann-Brown JA. Long-term Retrieval Success Rate Profile for the Günther Tulip Vena Cava Filter. J Vasc Interv Radiol 2009; 20:871-7; quiz 878. [DOI: 10.1016/j.jvir.2009.03.033] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 02/06/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022] Open
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A “Buddy Wire” Technique for Successful OptEase Filter Retrieval. J Vasc Interv Radiol 2009; 20:656-9. [DOI: 10.1016/j.jvir.2009.01.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 01/09/2009] [Accepted: 01/11/2009] [Indexed: 11/22/2022] Open
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Techniques Used for Difficult Retrievals of the Günther Tulip Inferior Vena Cava Filter: Experience in 32 Patients. J Vasc Interv Radiol 2009; 20:92-9. [DOI: 10.1016/j.jvir.2008.10.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 10/01/2008] [Accepted: 10/04/2008] [Indexed: 11/19/2022] Open
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Assessment of Snared-Loop Technique When Standard Retrieval of Inferior Vena Cava Filters Fails. Cardiovasc Intervent Radiol 2008; 32:145-9. [DOI: 10.1007/s00270-008-9446-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 09/01/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
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Embedded Inferior Vena Cava Filter Removal: Use of Endobronchial Forceps. J Vasc Interv Radiol 2008; 19:1297-301. [DOI: 10.1016/j.jvir.2008.04.012] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 04/08/2008] [Accepted: 04/15/2008] [Indexed: 11/21/2022] Open
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Marquess JS, Burke CT, Beecham AH, Dixon RG, Stavas JM, Sag AA, Koch GG, Mauro MA. Factors Associated with Failed Retrieval of the Günther Tulip Inferior Vena Cava Filter. J Vasc Interv Radiol 2008; 19:1321-7. [DOI: 10.1016/j.jvir.2008.06.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Revised: 05/30/2008] [Accepted: 06/03/2008] [Indexed: 11/28/2022] Open
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Analysis of tilt of the Günther Tulip filter. J Vasc Interv Radiol 2008; 19:669-76. [PMID: 18440454 DOI: 10.1016/j.jvir.2008.01.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 01/16/2008] [Accepted: 01/21/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine the frequency, dimensions, predictors, and sequelae of Günther Tulip filter (GTF) tilt measured at the time of intended retrieval. MATERIALS AND METHODS Retrospective review of all medical records and posteroanterior cavograms of 175 patients who underwent both placement and retrieval of the GTF between August 2003 and July 2007 was performed to assess the frequency, dimensions, predictors, and sequelae of tilt. RESULTS Tilt occurred at the first retrieval attempt in 159 of the 175 patients (91%). The average degree of tilt was 7.1 degrees (range, 0 degrees-30 degrees), with 87 of the 159 filters with tilt (55%) having a rightward tilt. Compared with the femoral approach, filters placed with a jugular approach demonstrated 4.2 degrees (range of the standard deviation, 3.1 degrees-5.3 degrees) greater tilt at the first retrieval attempt (95% confidence interval=2.6 degrees, 5.7 degrees; P<.001, two-sided Student t test), a greater frequency of tilt of at least 14 degrees (P=.002, two-sided Fisher exact test), and greater rightward tilt predominance (P=.046, one-sided Fisher exact test). Tilt magnitude at the first retrieval attempt correlated positively with the inferior vena cava diameter 40 mm caudal to the renal vein confluence (R=.183, P=.018, Pearson correlation). Within its limitations, this study detected no new cases of pulmonary embolism, caval perforation, or GTF migration. The success rates at the first attempt at retrieval and the cumulative GTF retrieval success rates were 93% (176 of 190 filters) and 97% (181 of 190 filters), respectively. All 29 GTFs with tilt of at least 14 degrees were placed and successfully retrieved by means of a jugular approach with minimal clinical and technical sequelae. CONCLUSIONS Frequent GTF tilt detected at the first retrieval attempt can reach at least 14 degrees and is associated with minimal sequelae. Insertion approach and caval diameter are significant factors in GTF tilt.
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